| Objective : To study the intraoperative awareness situation of elderly patients who use dexmedetomidine under the monitoring of the bispectral index.Methods: Select 60 cases of elderly patients,who will do the elective open reduction and internal fixation of femoral shaft fracture, aged 65-70 years old, weighing 50-60 kg, ASA I ~ â…¡grade. Patients were randomly divided into two groups, the observation group D(dexmedetomidine group) and control group M(midazolam group), 30 cases in each group. The induction and maintenance of anesthesia in group D with the dexmedetomidine, group M with midazolam. All patients must within 12 hours solid food and 8 hours liquid fasting, intramuscular inject atropine 0.5mg within 30 minutes before entering the operating room.When the patient enter the operating room, who need to be confirmed the patency of intravenous infusion, monitored the systolic and diastolic blood pressure,heart rate and oxygen saturation;EEG monitors were used for the bispectral index(BIS) monitoring. Before administration(T0),after administration(T1),after tracheal intubation(T2),at 30 min of operation(T3),at the end of operation(T4),tracheal extubation(T5),heart rate, systolic blood pressure,diastolic blood pressure were taken for comparison;to maintain the same bispectral(BIS) state(50-60) comparison of intraoperative propofol maintenance dosage and restlessness;compare two groups of dizziness,vomiting,chills,glossocoma and other adverse reactions occur;questionnaire investigation to the patient on the third day after operation and evaluated the occurrence of intraoperative awareness.Results :1.There were no significant differences between patients of the two groups in sex, age,weight,surgical site,ASA classification,surgical time or the clinical diagnosis(P>0.05).2.Changes in heart rate of the two groups of patients: Comparison between groups, at T2,T3,T4 point D group was significantly lower than the group M(P <0.05),one patients required the atropine,at T0,T1 and T5 point HR difference between the two groups was not statistically significant(P>0.05);Comparison within the group,D group comparing with the previous administration of T0,T1 and T3 point heart rate was significantly lower(P <0.05).3. Changes in blood pressure in both groups of patients: comparison between groups,at T2-T4 point D group systolic and diastolic blood pressure were lower than the M group(P<0.05),at T0,T1 and T5 point the difference between two groups systolic blood pressure, diastolic blood pressure was not statistically significant(P>0.05); Comparison within the group, D group at T1 SBP decreased significantly(P<0.05),M group at T2,T3,T4 point SBP increased significantly(P<0.05),at T3,T4 point DBP increased significantly(P <0.05).4. Propofol maintenauce dosage in D group was significantly less than the amount of M group(P<0.05);breathing recovery time,recovery and extubation time comparing between the two groups has no significant difference(P>0.05);restlessness incidence in D group was significantly less than M group(P <0.05).5.D group vomiting,chills,glossocoma incidence was significantly lower than that in group M(P<0.05), the incidence of dizziness difference between the two groups was not significant(P>0.05).6.Intraoperative awareness incidence in two groups has no significant difference(P>0.05).Conclusion: Dexmedetomidine group compare to the traditional midazolam group in the same conditions sedation, all of them can reduce the incidence of intraoperative awareness, but the patients who in the dexmedetomidine group hemodynamic is more stable, less dosage of anesthetic drugs, awakening period in patients with higher quality,and may be more suitable for elderly patients anesthesia. |
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